Nephrology

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A drawing of the human kidney from Gray's Anatomy.

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Editors-In-Chief: C. Michael Gibson, M.S., M.D. [1], Vijay Lapsia, M.D. Assistant professor of Medicine/Nephrology, Medical Director, Mount Sinai Kidney Center. [2], and Stephanie Fernandez, M.D. [3]


Nephrology is the branch of internal medicine dealing with the study of the function and diseases of the kidney. The word nephrology is derived from the Greek word nephros, which means "kidney," and the suffix -ology, signifying "study of."

Scope of the specialty

Nephrology concerns itself with the diagnosis and treatment of kidney diseases including electrolyte disturbances and hypertension, and the care of those requiring renal replacement therapy, including dialysis and renal transplant patients. Many diseases affecting the kidney are not limited to the organ itself, but are systemic disorders, and may require not only a whole patient approach, but also special treatment, such as systemic vasculitides or other autoimmune diseases, such as lupus.

Who sees a nephrologist?

Patients are referred to nephrology specialists for various reasons, such as:

Urologists are surgical specialists of the urinary tract - see Urology. They are involved in renal diseases that might be amenable to surgery:

  • Diseases of the Bladder and prostate such as malignancy, stones, or obstruction of the urinary tract.

Diagnosis

As with the rest of medicine, important clues as to the cause of any symptom are gained in the history and physical examination. For example, pink and white nails are associated with kidney disease.

Laboratory tests are almost always aimed at: urea, creatinine, electrolytes, and urinalysis-- which is frequently the key test in suggesting a diagnosis.

More specialized tests can be ordered to discover or link certain systemic diseases to kidney failure such as hepatitis B or hepatitis C, lupus serologies, paraproteinemias such as amyloidosis or multiple myeloma or various other systemic diseases that lead to kidney failure. Collection of a 24-hour sample of urine can give valuable information on the filtering capacity of the kidney and the amount of protein loss in some forms of kidney disease. However, 24-hour urine samples have recently, in the setting of chronic renal disease, been replaced by spot urine ratio of protein and creatinine.

Other tests often performed by nephrologists are:

Therapy

Many kidney diseases are treated with medication, such as steroids, DMARDs (disease-modifying antirheumatic drugs), antihypertensives (many kidney diseases feature hypertension). Often erythropoietin and vitamin D treatment is required to replace these two hormones, the production of which stagnates in chronic renal disease.

When symptoms of renal failure become too severe, dialysis might be required. Please refer to dialysis for a comprehensive account of this treatment.

If patients proceed to renal transplant, nephrologists often monitor the immunosuppressive regimen and the infections that can occur at this stage.

See Also

Pioneers in Nephrology

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ca:Nefrologia de:Nephrologie et:Nefroloogia eu:Nefrologia gl:Nefroloxía id:Nefrologi it:Nefrologia he:נפרולוגיה lt:Nefrologija hu:Nefrológia nl:Nefrologie fi:Nefrologia sv:Nefrologi



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